No Need to Screen All Adults for Clogged Neck Arteries, Experts Say

Adults in the general population should not be screened for narrowing of the neck arteries, according to a draft recommendation from the influential U.S. Preventive Services Task Force (USPSTF).

Narrowing of the neck arteries, formally called “carotid artery stenosis,” reduces blood flow to the brain and is a risk factor for stroke.

“The carotid artery is the blood vessel that brings blood to the brain,” explained Dr. Peter Faries, chief of vascular surgery at the Mount Sinai Hospital in New York City. “It starts in the chest and travels through the neck until it enters the skull.”

Faries, who was not involved in drafting the new recommendations, explained that a buildup of fatty deposits in the carotid artery can lead to “narrowing or blockage of the blood flow to the brain. These carotid narrowings, or stenosis, can lead to a stroke in the patients that have them.”

He said, “Often times, the first indication that a stenosis is present in the carotid artery is when the patient suffers a stroke.”

Doctors have long wondered then if routinely screening adults for narrowed neck arteries might be a good idea. But the USPSTF panel said that their review of the available evidence does not favor widespread screening.

The recommendation does not apply to adults with any history of stroke, mini-stroke, or signs and symptoms of stroke, however.

Carotid artery narrowing “is uncommon in the general adult population, so screening everyone would lead to many false positive results,” panelist Dr. Jessica Herzstein explained in a news release issued by the task force. “This can lead to follow-up tests and surgery that carry risk of serious harms, including stroke, heart attack, and death.”

A false positive result occurs when a test indicates that a person has a condition that’s not actually there.

“Screening for carotid stenosis can be performed using ultrasound,” Faries added. “The carotid screening ultrasound test is safe, simple, quick, effective, completely non-invasive, does not require any exposure to radiation, and inexpensive.”

Faries agreed with the USPSTF panel that screening should be reserved for patients at risk for the development of carotid artery blockage and stroke. That includes people over the age of 65 who are at high risk for “hardening of the arteries,” with conditions such as high cholesterol, heart disease, a family history of stroke or a history of smoking.

In such cases, “screening can be an effective method of identifying blockages in the carotid artery, allowing them to be treated and thereby preventing a stroke from occurring,” Faries explained.

All the experts agreed that preventing vessels from narrowing in the first place is the best option of all.

“The good news is that we have ways to reduce the risk of a stroke: control blood pressure and cholesterol, don’t smoke, be physically active, and eat a healthful diet,” task force co-vice chair Dr. Michael LeFevre said in the news release.

Faries echoed that notion. “Preventing a stroke before it occurs is obviously preferable to treating the blockage after a patient has suffered a stroke,” he said.

The draft recommendation is posted on the task force’s website and will be open for public comment until March 17. The task force is an independent advisory group of health experts.